By Jennifer McAlister, MD, FACS
When a pregnant woman discovers a mass or swelling in only one breast, it shouldn’t be ignored. Breast cancer, although rare during pregnancy, is a possibility. Breast cancer affects about 0.03 percent, or 1 in 3,000, pregnant women.
One component of breast cancer treatment during pregnancy that may seem obvious but can be overlooked is the emotional component. Pregnancy is supposed to be a time of great joy and anticipation, and suddenly a mother has to face decisions—for herself and her family—she never expected to make. It’s important for the mother, her partner and her physicians to address these emotions.
These emotions can feel like a devastating blow. A woman can expect to experience grief related to not only the cancer, but the treatment’s effects, including the possibly of losing her hair or the possibly of losing a breast. There may also be feelings of guilt from not being able to breastfeed.
The distinguishing aspect of caring for a pregnant woman with breast cancer is that of caring for both mother and baby. Most women who become pregnant have not undergone screening mammography, which should begin yearly at age 40. Typically, all radiation is avoided during pregnancy. Fortunately, there are other ways to image the breast during pregnancy such as a breast ultrasound. Mammography can be performed after the first trimester with a shield over the abdomen.
Once diagnosed, treatment is dependent on both the stage of the cancer as well as the stage of the pregnancy. Typically, in the first trimester, a mastectomy is recommended. Chemotherapy, in general, is not recommended in the first trimester. In the second trimester, many chemotherapy regimens can be safely used.
Surgery for breast cancer is typically safe at all stages of pregnancy. A woman’s choice for lumpectomy versus mastectomy is affected by the stage of pregnancy. Since a lumpectomy needs to be followed by radiation shortly after surgery, it may not be possible early in the pregnancy. Hormonal treatment is never offered during pregnancy.
What pregnant women who are diagnosed with breast cancer should realize is that with support from a multidisciplinary team, breast cancer treatment can be made as safe as possible for both mother and baby.